Objective To investigate the relativity between morning blood pressure surge (MBPS) and carotid atheresclerosis. Methods Noninvasive ambulatory blood pressure monitor (ABPM) was per-formed on 97 patients with the first and second stage of essential hypertension and according the ABPM re-suits, the patients were classified into MP+ group (31 cases) and MP-group (66 cases). In the meantime, the carotid intima-media thickness (IMT) and the carotid atheresclerotic plaque was examined by the color Doppler ultrasound. The relationship among MBPS, carotid atherosclerotic plaque and IMT was analyzed.Results The IMT of common carotid artery (CCA), carotid artery bifurcation (CAB)and internal carotid artery (ICA) in MP+ group was significantly higher than that in MP- group [ (1.02±0.36)mm vs (0.86±0.22) mm, (1.14±0.39 ) mm vs(0.96±0.26) mm, (0.94±0.30 )mm vs ( 0.82±0.18 mm ), P<0.05 ]. The ratio of carotid atherosclerotie plaque in MP+ group was significantly higher than that in MP- group (64.5% vs 42.4%,P<0.05). Conclusions The MBPS is related to carotid atheroselerotie plaque and the carotid IMT. The MBPS may accelerate the forming and developing of atherosclerosis.

Objective To study the metabolic profiles in the urine samples of rats dosed with decoction of the caulis of Aristolochia manshuriensis and the relationship between the results of blood biochemical analysis and histopathological analysis,and to explore the feasibility of the application of NMR-based metabonomics to toxicology of Chinese medicine.Methods Male Wistar rats were administrated by ig 36,32,28,and 24 g/kg of A.manshuriensis or the equal volume of distilled water for 6 d,respectively.Urine were collected and their()~1H-NMR spectra were acquired,and then subjected to data process and principal component ana-(lysis)(PCA).Blood biochemical analysis and histopathological examination were carried out.Results(Compared) to control groups,the urinary concentrations of TMAO,taurine,creatinine,DMG,citrate,and DMA in dosed groups decreased,while those of acetate,alanine,and some other amino acids increased to a great extent.The dosed groups can be readily discriminated from the controls based on PCA,with acetate and TMAO as main discriminators.A good agreement was achieved within clinical chemistry,microscopically examination and PCA data.Conclusion The caulis of A.manshuriensis can induce renal lesion as revealed by the metabonomic analysis of rat urine samples as well as blood biochemical analysis and histopathological examinations.The results show that the metabonomic approach is a promising new technology in toxicology.

Objective:To explore the clinical significance of combined detecting serum cystatin C (Cys-C),retinol binding protein (RBP),high sensitive C reactive protein (hsCRP)and urine microalbuminuria (UMA)for early re-nal damage detection in patients With essential hypertension (EH).Methods:Levels of Cys-C,RBP and UMA Were measured in 83 EH patients (EH group)and 80 healthy objects With similar age (healthy control group)respective-ly.Positive rates (exceeding upper limit of normal value for above index Was regarded as positive) of single and combined use of above indexes Were calculated.Results:Compared With healthy control group,there Were signifi-cant increase in levels of Cys-C [(0.98±0.30)μg/ml vs.(1.23±1.38)μg/ml],RBP [(38.32±10.10)mg/L vs. (41.67±11.68)mg/L],and UMA [(1.17±0.46)mg/L vs.(3.01±3.31)mg/L]in EH group (P<0.05 or <0.01),and their detection rates for early renal damage Were 21.69%,19.28%,14.46% and 19.28% respectively. Combined detecting rates of Cys-C + UMA and UMA+ RBP Were 36.14% and 34.94% respectively,Which Were significantly higher than those of single index (P<0.05 all).Conclusion:Proper multi-index combined detecting can effectively raise the detection rate of early renal damage in patients With hypertension.

Objective To evaluate characteristic clinical and imaging findings of pancreatic neuroendocrine tumors (NET) in dual-phase contrast enhancement MSCT.Methods The dual-phase contrast enhancement MSCT images of 23 lesions in 20 patients with histologically confirmed pancreatic NET were studied retrospectively.Their clinical presentations,imaging characters as well as the intensities of lesions and normal pancreas in each phase were measured,and the following indices were calculated.First,the absolute enhancement of lesions,including the increasing of CT value of the maximum enhancement area within a tumor in arterial phase,that was named A1 in short,and that of the minimum enhancement area was labeled as A2.The same ROI measured increasing CT values in portal venous phase was labeled as V1 and V2 respectively.Secondly,the relatively enhancement indices comparing with the normal pancreas in the same patient within the same phase were calculated.This included the differences between the maximum,as well as the minimum,enhancement areas of tumors and the normal pancreas in arterial phase,which was named as AP1 and AP2 respectively,and those differences in portal venous phase,which were labeled as VP1 and VP2 respectively.All of the tumors were graded as G1 to G3 according to the WHO classification in 2010.A Kruskal Wallis test were performed to compare differences of tumor diameters and the enhancement indices.The change trend of enhancement indices varying with pathology grading were described.Fisher exact test was used to find differences of clinical and imaging characters.Results Twenty-three lesions in 20 patients included 13 lesions in grade 1 (G1),8 in G2,and 2 in G3.Among the 10 patients with G1 NET,7 of them had no endocrine symptoms,while the other 3 had endocrine symptoms.Six of them had no abdominal pain,while 4 of them complained of it.All of the 10 patients with G1 NET had no hepatic metastasis.Among 8 patients with G2 NET,4 of them were with endocrine abnormality,and the other 4 were not.Five of them complained of abdominal pain while the other 3 did not.Six of them had no hepatic metastasis,and 2 of them had.Both of the 2 patients with NET in G3 did not have any endocrine abnormality,and one of them complained abdominal pain.Both of them were with hepatic metastasis.There was no difference between groups that whether or not endocrine syndrome and abdominal pain was presented (x2 =2.238,0.713,P =0.318,1.000),while hepatic metastasis was of significant differences (x2 =9.516,P =0.003).Tumor location,distinct outline,necrosis and/or calcification were not significantly different.Tumor enhancement showed a probable trend of decrease in group of higher grade.A1 decreased from (126.4 ± 45.7)HU to (38.7± 8.5)HU (x2 =7.254,P=0.027),A2 decreased from (94.1 ±31.1)HU to (22.8 ± 14.0) HU (x2 =7.323,P =0.026) and AP1 dropped from 80.6 HU(-21.8 — 169.7 HU) to -36.7 HU(-41.6—-31.7 HU) (x2 =6.778,P =0.034).All of the indices mentioned above were of significant difference and the other indices showed no significant difference (P ＞ 0.05).Conclusions Quantitative assessment of their enhancement patterns may provide useful information to preoperative grading of pancreatic NET,and tumors in a higher grade may show poorer enhancement.

ve To evaluate the performance of the target controlled infusion (TCI) system of midazolam for sedation during operation in terms of safety and ease of use in the elderly and the young. Methods Forty-four unpremedicated ASA I - II patients scheduled for elective surgery under epidural or combined spinal-epidural (CSE) anesthesia were included in this study. The patients were divided into two age groups: the elderly group aged 61-82 yr ( n = 22) and the young group aged 19-43 yr (n = 22) . Patients with neurological or severe cardiopulmonary diseases or abnormal liver or kidney function were excluded. The block height was maintained below T4. The TCI system consisted of Intel Pentium III 450 MHz computer and Graseby 3500 computerized infusion pump. The software we used was Stelpump Version 1.05 written by Pina and Coetzee and the pharmacokinetic model and parameter were described by Arram and Buhrer. The effect site concentration of midazolam was targeted and started from 50ng?ml-1, then increased in increment of 50 ng?ml-1 (in the young group) or 25ng?ml-1 (in the elderly group) until the patient did not respond to light shaking (defined as unconsciousness) . Each incremental increase was maintained for 15 min. Arterial blood samples were taken in ten patients randomly selected from each group at 10 and 15min after each incremental increase of midazolam concentration for determination of plasma midazolam concentration by high performance liquid chromatography ( HPLC) .Results The bias (median performance error) of the TCI system of midazolam was 7.9% in the elderly group and 11.6% in young groups. The precision (median absolute performance error) was 20.0% in both groups. They were clinically acceptable. Conclusions The TCI system of midzolam can provided sedation for patients undergoing surgery under spinal and/or epidural anesthesia safely and efficiently in both the old and young.

Objective To assess the changes in heart rate variability (HRV) during midazolam sedation with TCI in the elderly and young patients. Methods Thirty-eight ASA I - Ⅱ patients scheduled for elective surgery on lower abdomen or lower extremities under epidural or combined epidural-spinal anesthesia were divided into two groups of 19 patients each: the young group (18-40 yr) and the elderly group (60-89 yr). Radial artery was cannulated for intra-arterial pressure monitoring and blood sampling. HRV was monitored by HXD-1 monitoring system. HRV parameters included total power (TP), low frequency(LF), high frequency(HF), LF/HF, nuLF(LF/TP ?100%) and NuHF(HF/TP ? 100%) . The height of block was maintained below T5. TCI was used to achieve a rapid induction and maintenance of a stable target blood midazolam concentration. Target blood midazolam concentration was started from 50 ng/ml and gradually increased with increment of 25 ng/ml in elderly group or 50ng/ml in the young group until loss of consciousness (OAA/S =1). Arterial blood samples were taken at each target blood midazolam concentration for determination of blood midazolam concentration. HRV parameters were recorded at different OAA/S scores during both the induction of and recovery from sedation. Results With increasing depth of sedation, most of the HRV parameters (LF, nuLF, LF/HF and TP) decreased progressively, while nuHF increased and HF remained unchanged. During recovery from midazolam-induced sedation, HRV parameters returned gradually to the baseline values. OAA/S scores and HRV parameters were well correlated(r = 0.502-0.719). The trend of changes in HRV was consistent in both groups. At the same OAA/S score, most values of HRV parameters were not significantly different between the two groups. Only during deep sedation (OAA/S=1), values of all HRV parameters were significantly lower in the elderly group than those in the young group, except LF/HF. Conclusions During profound sedation (OAA/S=1) midazolam depresses the activity of the autonomic nervous system more markedly in the elderly than in the young, but the elderly without cardiovascular and autonomic nervous system disorders has the same ability to keep the balance between the sympathetic and parasympathetic nervous system as theyoung.

0.05). The requirement of vasoactive drugs in the group A was significantly smaller than that in the group B (P

0.05).A similar amount of propofol was used in each group.A significantly higher dose of sufentanil was administered in the Group C(73.9?13.6 ?g)than in the Group A(24.3?4.9 ?g)and the Group B(35.4?8.1?g)(qC-A=237.924,P=0.000;qC-B=119.385,P=0.000).The expected time of recovering consciousness was shorter in the Group A and B than in the Group C.Conclusions Administered by target-controlled infusion with propofol,sufentanil dose-dependently reduces BIS and modifies hemodynamic responses during anesthesia induction.The target effect-site sufentanil concentration of 0.6 ng/ml combined with plasma propofol concentration of 3 ?g/ml is suitable for anesthesia induction for short-time laparoscopic operation.

ObjectiveTo investigate the characteristics of gastroesophageal reflux disease (GERD) with chronic cough by the results of combined multichannel intraluminal impedance and high-resolution manometry (MII-HRM) procedure and 24-hour muhichannel intraluminal impedance combined pH (MII pH) monitoring.Methods From March 2010 to November 2010,consecutive patients of GERD with chronic cough (more than 8 weeks) admitted to Beijing Chaoyang Hospital of Capital Medical University underwent 24-hour MII-pH monitoring and MII-HRM procedure with symptom association probability(SAP) over 95％.Data of lower esophageal sphincter (LES) pressure,LES relaxation,LES residual pressure,esophageal body peristalsis function and swallow bolus transit (liquid/viscous) was collected and the result of 24-hour MII-pH monitoring was analysed by the computer software containing reflux episode activity(acid/nonacid,upright/recumbent),proximal extent,acid exposure and mean acid/bolus clearance time.Seventeen patients of GERD with typical reflux symptom were selected as the control group.ResultsComparing with patients of GERD with typical reflux symptom,patients of GERD with chronic cough showeddecreased upper esophageal sphincter pressure (UESP) [( 122.55 ± 60.48 )mm Hg vs ( 86.37 ± 41.35 ) mm Hg,P ＜ 0.05,1 mm Hg =0.133 kPa ],higher percentage of abnormality peristalsis [(9.47 ± 15.63 ) ％ vs ( 22.16 ± 17.45 ) ％,P ＜ 0.05 ],degraded esophagus transmittability of liquid substance [( 88.82 ± 12.23) ％ vs ( 71.68 ± 23.06 ) ％,P ＜ 0.05 ],more reflux episode activity ( acid/nonacid ) in supine position and proximal reflux episode (nonacid) in supine position (P ＜ 0.05 )and longer mean bolus clearance time( P ＜ 0.05 ).Conclusion Decrease of the UESP,increase of the reflux episode activity (acid/nonacid) in supine position and proximal reflux episode (nonacid) in supine position,lengthened mean bolus clearance time in supine position and the degraded esophagus clearance ability may all correlated with the pathogenesy of GERD with chronic cough.

Objective To evaluate the diagnostic performance of multi ? b value DWI to differentiate pancreatic adenocarcinoma from healthy pancreas using the apparent diffusion coefficient (ADC) and parameters derived from the intravoxel incoherent motion (IVIM) theory. Methods Forty?eight patients with histopathologically proven pancreatic adenocarcinoma and fifty patients with healthy pancreas were examined at 3.0 Tesla using a single?shot echo?planar imaging DWI pulse sequence. Eight b?values ranging from 0 to 1 000 s/mm2 were used. ADC, diffusion coefficient (D), perfusion?related diffusion (D*) and perfusion fraction (f) were compared between pancreatic adenocarcinoma and healthy pancreas, t test or Mann?Whitney U test was used to compare the MRI parameters, ROC was used to evaluate the diagnostic efficiency. Results In comparison to healthy pancreatic tissue, a significant reduction of the ADC, D*and f was found in pancreatic adenocarcinoma [healthy pancreatic tissue:(1.68±0.31)×10-3mm2/s, 27.10×10-3mm2/s, (36.92±12.47)%;pancreatic adenocarcinoma:(1.51±0.37)×10-3mm2/s, 13.90×10-3mm2/s, (30.06±19.84)%] (P<0.05). No significant difference in the diffusion coefficient D was observed between the two groups (1.06× 10-3 and 1.26 × 10-3mm2/s; P>0.05). In the ROC?analyses, the area under curve for D* was the largest (0.727), followed by f and ADC in order (0.680 and 0.669). Conclusion Using the IVIM DWI approach, the D*, f and ADC value are useful for differentiating pancreatic adenocarcinoma from healthy pancreatic tissue.